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1.
Gerontology ; 68(2): 121-135, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34091448

RESUMO

INTRODUCTION: Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. METHODS: We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. RESULTS: The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of "awareness and knowledge," "recognition and detection," "evaluation," "management," "support," and "services and policies." Pragmatic options for implementation for each domain were then developed. CONCLUSION: This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Disfunção Cognitiva/diagnóstico , Demência/complicações , Demência/diagnóstico , Demência/terapia , Audição , Humanos , Pesquisa Qualitativa , Inquéritos e Questionários
2.
Brain Inj ; 36(1): 110-120, 2022 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-35253554

RESUMO

BACKGROUND: Moderate-to-severe traumatic brain injury (TBI) follows a chronic neuro-psychological sequelae, interfering with quality of life (QOL). OBJECTIVE: To investigate the chronic effects of moderate-to-severe TBI as expressed by greater atrophy in specific regions-of-interest relating to executive functions (EF) and self-awareness (SA); and whether this atrophy reflects on EF, SA deficits and QOL. METHODS: Thirty-one males with chronic moderate-to-severe TBI, aged 18-51, were compared to 24 non-injured males (age range = 21-49), matched on age and education. EF was assessed through a composite score. SA and QOL were assessed using generic and TBI-specific measures. Online masks were applied on magnetic resonance images to extract EF and SA - related regions-of-interest. RESULTS: Findings revealed that participants with TBI presented with less volume in fronto-temporal cortical and subcortical regions, than controls. An interrelation between EF and SA - related regions was revealed. Participants with TBI scored lower on neuropsychosocial measures, than controls. Differences in EF and SA were reflected on the related regions-of-interest. Satisfaction with QOL was predicted by these regions-of-interest. CONCLUSION: Chronic TBI effects on brain volume extend on EF, SA, and QOL; highlighting the role of SA between EF and QOL, and the need for personalized interventions in improving recovery outcome.


Assuntos
Lesões Encefálicas Traumáticas , Lesão Encefálica Crônica , Adulto , Atrofia , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/psicologia , Função Executiva , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Adulto Jovem
3.
Alzheimers Dement ; 18(10): 1957-1968, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35184367

RESUMO

As research and services in the Mediterranean region continue to increase, so do opportunities for global collaboration. To support such collaborations, the Alzheimer's Association was due to hold its seventh Alzheimer's Association International Conference Satellite Symposium in Athens, Greece in 2021. Due to the COVID-19 pandemic, the meeting was held virtually, which enabled attendees from around the world to hear about research efforts in Greece and the surrounding Mediterranean countries. Research updates spanned understanding the biology of, treatments for, and care of people with Alzheimer's disease (AD_ and other dementias. Researchers in the Mediterranean region have outlined the local epidemiology of AD and dementia, and have identified regional populations that may expedite genetic studies. Development of biomarkers is expected to aid early and accurate diagnosis. Numerous efforts have been made to develop culturally specific interventions to both reduce risk of dementia, and to improve quality of life for people living with dementia.


Assuntos
Doença de Alzheimer , COVID-19 , Humanos , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/terapia , Doença de Alzheimer/diagnóstico , Qualidade de Vida , Pandemias , Biomarcadores
4.
Medicina (Kaunas) ; 57(8)2021 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-34440995

RESUMO

Background and Objectives: There is strong evidence in the literature that women experience psychological disorders at significantly higher rates than men. The higher rates of psychological disorders in women may partly be attributable to gender differences in response to stressors and coping styles. The objective of this study was to contribute to the growing body of literature investigating gender differences in mental health outcomes and coping styles during the coronavirus disease 2019 pandemic in a large sample of individuals from 59 countries with variable demographic and socio-cultural characteristics. Materials and Methods: Survey data were collected from the general population following a snowball sampling method, and the survey was promoted through social media platforms and mailing lists. Participants included 6882 individuals from the general population from 59 countries around the world. A combination of both standardized and adapted measures was used to create a survey, originally in English and then translated to Spanish, Italian, French, German, and Turkish. Results: Compared with men, women presented with higher levels of trauma-related distress; had a harder time decompressing; were more depressed, anxious and stressed; showed decreased frustration tolerance and reported lower quality of sleep and an increased likelihood of taking sleep medication or other natural sleep remedies. Overall, women tended to be more vulnerable during the pandemic in developing symptoms consistent with various forms of mental disorders such as depression, anxiety and post-traumatic distress. However, they also were more likely than men to use a variety of adaptive coping strategies, including concentrating on doing something about the situation and getting emotional support from others. Conclusions: A high prevalence of mood symptoms was noted among women. In addition to meeting the physical health needs of the population, emphasis needs to be given to mental health and the prevention of psychiatric disorders, particularly in women.


Assuntos
COVID-19 , Quarentena , Ansiedade , Depressão/epidemiologia , Feminino , Humanos , Masculino , Pandemias , SARS-CoV-2 , Fatores Sexuais , Estresse Psicológico/epidemiologia
5.
Int J Geriatr Psychiatry ; 35(4): 348-357, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31713262

RESUMO

OBJECTIVES: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes. METHODS: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed. RESULTS: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication. CONCLUSIONS: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.


Assuntos
Disfunção Cognitiva/complicações , Demência/complicações , Transtornos da Audição/etiologia , Transtornos da Audição/terapia , Perda Auditiva/reabilitação , Perda Auditiva/terapia , Qualidade de Vida/psicologia , Transtornos da Visão/etiologia , Transtornos da Visão/terapia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Terapia Cognitivo-Comportamental , Demência/psicologia , Inglaterra , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade
6.
Neuropsychol Rehabil ; 30(6): 1024-1043, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30444178

RESUMO

The Dysexecutive Questionnaire is a sensitive and ecologically valid measure of everyday dysexecutive symptoms. Recently, a revised version of the tool has been proposed (DEX-R). The current study aimed to examine the factorial validity of the Greek DEX-R, the level of agreement between the self and informant rating versions and the effect of age on each dysexecutive symptoms component. The questionnaire was administered to a sample of older adults (n = 235) and to a sample of informants (n = 187) in the context of the Neurocognitive Study for the Aging in Cyprus. Confirmatory Factor Analysis results showed that dysexecutive symptoms can be grouped into three underlying components or factors: (a) Motivation and Attention, (b) Flexibility, Fluency and Working Memory, and (c) Social Self-Regulation. Overall, the elderly reported more symptoms than their relatives, however the difference was significant only for the Flexibility, Fluency and Working memory factor. In a structural equation model, a weak positive effect of age was observed on the Flexibility, Fluency and Working Memory factor, based on the informant ratings. This study provides empirical evidence about the use of the DEX-R questionnaire in the Greek-speaking elderly population as a valid and reliable measure of everyday dysexecutive symptoms.


Assuntos
Envelhecimento/fisiologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/fisiopatologia , Função Executiva/fisiologia , Testes Neuropsicológicos/normas , Idoso , Chipre , Análise Fatorial , Feminino , Humanos , Análise de Classes Latentes , Masculino , Reprodutibilidade dos Testes
7.
Age Ageing ; 48(4): 580-587, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-30608511

RESUMO

BACKGROUND: there is a significant gap in the understanding, assessment and management of people with dementia and concurrent hearing and vision impairments. OBJECTIVE: from the perspective of professionals in dementia, hearing and vision care, we aimed to: (1) explore the perceptions of gaps in assessment and service provision in ageing-related hearing, vision and cognitive impairment; (2) consider potential solutions regarding this overlap and (3) ascertain the attitudes, awareness and practice, with a view to implementing change. METHODS: our two-part investigation with hearing, vision, and dementia care professionals involved: (1) an in-depth, interdisciplinary, international Expert Reference Group (ERG; n = 17) and (2) a wide-scale knowledge, attitudes and practice survey (n = 653). The ERG involved consensus discussions around prototypic clinical vignettes drawn from a memory centre, an audiology clinic, and an optometry clinic, analysed using an applied content approach. RESULTS: the ERG revealed several gaps in assessment and service provision, including a lack of validated assessment tools for concurrent impairments, poor interdisciplinary communication and care pathways, and a lack of evidence-based interventions. Consensus centred on the need for flexible, individualised, patient-centred solutions, using an interdisciplinary approach. The survey data validated these findings, highlighting the need for clear guidelines for assessing and managing concurrent impairments. CONCLUSIONS: this is the first international study exploring professionals' views of the assessment and care of individuals with age-related hearing, vision and hearing impairment. The findings will inform the adaptation of assessments, the development of supportive interventions, and the new provision of services.


Assuntos
Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/terapia , Perda Auditiva/diagnóstico , Perda Auditiva/terapia , Transtornos da Visão/diagnóstico , Transtornos da Visão/terapia , Idoso , Consenso , Demência/diagnóstico , Demência/terapia , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Comunicação Interdisciplinar , Internacionalidade , Transtornos da Memória/diagnóstico , Transtornos da Memória/terapia
8.
J Integr Neurosci ; 18(2): 95-105, 2019 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-31321950

RESUMO

This research investigates the chronic effect of moderate to severe traumatic brain injury on brain white matter integrity, as reflected by diffusion tensor imaging metrics, and the assessment of their correlation to neuropsychological response. Thirteen male participants with traumatic brain injury (8.4 years average post-injury time) were compared to a matched group of neurologically healthy controls. None of the traumatic brain injury subjects had received post-acute neurocognitive and/or neuropsychological rehabilitation. Between-group comparison of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity was performed for the whole brain and corpus callosum. An extensive battery of visual and verbal memory tasks was employed for the comparative assessment of neurocognitive performance. Between-group and within-group performance differences were correlated with fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity of corpus callosum. Significant changes in global fractional anisotropy, mean diffusivity, and radial diffusivity were associated with traumatic brain injury. Visual memory capacity was reduced in traumatic brain injury, and this deficit was correlated to white matter integrity loss at the corpus callosum. Participants with traumatic brain injury underperformed controls in verbal memory as well, but no correlation with corpus callosum diffusion tensor imaging properties was established. Between-group performance difference was correlated with corpus callosum diffusion metrics in several tasks. Significant correlations were found between corpus callosum diffusion tensor imaging metrics and neuropsychological response within the traumatic brain injury group. Changes in whole brain and corpus callosum diffusion tensor metrics inflicted by moderate to severe traumatic brain injury are still evident several years post-injury and relate to neurocognitive impairment, while loss of white matter integrity seems to correlate with episodic and working memory impairment.


Assuntos
Lesões Encefálicas Traumáticas/patologia , Lesões Encefálicas Traumáticas/psicologia , Encéfalo/patologia , Corpo Caloso/patologia , Memória/fisiologia , Adulto , Imagem de Tensor de Difusão , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Comportamento Verbal/fisiologia , Percepção Visual/fisiologia , Adulto Jovem
9.
Semin Speech Lang ; 40(1): 3-12, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30616290

RESUMO

PURPOSE: Collegiate varsity athletes are at risk for sustaining a sports-related concussion, which can negatively impact performance during academic, social, work, and athletic endeavors. Because of the complex nature of concussions and high rates of underreporting by athletes, concussion education, identification, and postinjury care require a collaborative, multidisciplinary approach. Therefore, the purpose of this paper is to describe the specific responsibilities of the team members along with the established pre- and postconcussion procedures of one of the oldest university-based multidisciplinary concussion management programs that is coordinated by speech-language pathology. METHOD: The authors provide a theoretical review of current best practices for the multidisciplinary team along with a discussion of baseline and postconcussion neurocognitive assessment and management procedures directly involving speech-language pathology. Included is a case example illustrating the postinjury procedures utilized by the team. CONCLUSION: Management of the complex sequelae of sports-related concussion for the varsity collegiate athlete necessitates implementation of a multidisciplinary, collaborative approach. Speech-language pathologists' training in the assessment and treatment of brain injury provides the team with an objective perspective in the evaluation and postinjury management of the injured student athlete. While our understanding of concussions has improved greatly over the past two decades, researchers and clinicians on the front lines of care recognize that continued voids exist in our knowledge, with the need to continually explore new methods to identify and manage the complex immediate and potentially long-term ramifications of concussion.


Assuntos
Traumatismos em Atletas/terapia , Concussão Encefálica/terapia , Comunicação Interdisciplinar , Colaboração Intersetorial , Patologia da Fala e Linguagem , Serviços de Saúde para Estudantes , Concussão Encefálica/complicações , Concussão Encefálica/diagnóstico , Humanos , Síndrome Pós-Concussão/diagnóstico , Síndrome Pós-Concussão/etiologia , Síndrome Pós-Concussão/terapia , Guias de Prática Clínica como Assunto
11.
Hum Brain Mapp ; 38(2): 767-778, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27684499

RESUMO

Working memory is responsible for keeping information in mind when it is no longer in view, linking perception with higher cognitive functions. Despite such crucial role, short-term maintenance of visual information is severely limited. Research suggests that capacity limits in visual short-term memory (VSTM) are correlated with sustained activity in distinct brain areas. Here, we investigated whether variability in the structure of the brain is reflected in individual differences of behavioral capacity estimates for spatial and object VSTM. Behavioral capacity estimates were calculated separately for spatial and object information using a novel adaptive staircase procedure and were found to be unrelated, supporting domain-specific VSTM capacity limits. Voxel-based morphometry (VBM) analyses revealed dissociable neuroanatomical correlates of spatial versus object VSTM. Interindividual variability in spatial VSTM was reflected in the gray matter density of the inferior parietal lobule. In contrast, object VSTM was reflected in the gray matter density of the left insula. These dissociable findings highlight the importance of considering domain-specific estimates of VSTM capacity and point to the crucial brain regions that limit VSTM capacity for different types of visual information. Hum Brain Mapp 38:767-778, 2017. © 2016 Wiley Periodicals, Inc.


Assuntos
Encéfalo/anatomia & histologia , Encéfalo/fisiologia , Memória de Curto Prazo/fisiologia , Percepção Visual/fisiologia , Adolescente , Adulto , Atenção , Encéfalo/diagnóstico por imagem , Cognição , Feminino , Lateralidade Funcional/fisiologia , Substância Cinzenta/anatomia & histologia , Substância Cinzenta/diagnóstico por imagem , Voluntários Saudáveis , Humanos , Processamento de Imagem Assistida por Computador , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estimulação Luminosa , Adulto Jovem
13.
Folia Phoniatr Logop ; 67(3): 145-55, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26789266

RESUMO

BACKGROUND/AIMS: This study investigated quality of life (QoL) in relation to cognitive-linguistic performance and demographic characteristics (age, education and gender) in a large cohort of cognitively healthy older adults. METHOD: A total of 578 Greek-Cypriots aged 60-91 years were recruited from the Neurocognitive Study on Aging. Of those, 395 healthy participants (171 males and 224 females) who met all study criteria were retained. They completed measures of executive functioning, working memory, receptive vocabulary and confrontational naming in addition to the WHOQOL-BREF (brief version of the WHO QoL questionnaire). RESULTS: There were modest but significant relationships between executive functioning, working memory, vocabulary measures and the WHOQOL-BREF (p < 0.01). MANOVA yielded significant gender and education effects on QoL. Sequential stepwise regression confirmed that gender, depression scores and years of education made significant contributions to predicting the total score on WHOQOL-BREF and accounted for 31% of the variance (R² = 0.310). CONCLUSION: Self-reports of QoL remain stable in older adulthood. Demographic variables such as gender and years of education affected several domains of QoL, and, along with depression symptomatology, accounted for a significant part of the WHOQOL-BREF variance. Cognitive-linguistic measures correlated on the physical and psychological health domains of the WHOQOL-BREF in healthy older adults.


Assuntos
Afasia/diagnóstico , Afasia/psicologia , Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/psicologia , Testes Neuropsicológicos/estatística & dados numéricos , Qualidade de Vida/psicologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Chipre , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Inquéritos e Questionários
14.
Folia Phoniatr Logop ; 67(3): 119-30, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26788917

RESUMO

OBJECTIVE: To gain an insight into speech and language therapists' perspectives on and practices in quality of life in aphasia. PARTICIPANTS AND METHODS: The International Association of Logopedics and Phoniatrics Aphasia Committee developed a survey questionnaire, which was delivered online, anonymously, through SurveyMonkey (November 2012 to April 2013) to clinicians working with people with aphasia in 16 countries across the world. RESULTS: A large number of speech and language therapists responded to the survey, with 19/21 questions answered by 385-579 participants. Clinicians were well informed on what constitutes quality of life and viewed it as a complex construct influenced by health, participation, in/dependence, communication, personal factors, and environmental factors. In their clinical practice, they considered quality of life as important, used informal approaches to explore it and aimed to address quality of life goals; yet, the majority did not evaluate quality of life in a systematic way. CONCLUSION: There is a need for training on quality of life to help speech and language therapists incorporate quality of life outcome measures in their interventions. There is also a need for further research on which interventions improve quality of life in aphasia.


Assuntos
Afasia/psicologia , Atitude do Pessoal de Saúde , Comparação Transcultural , Qualidade de Vida/psicologia , Afasia/reabilitação , Inquéritos Epidemiológicos , Humanos , Capacitação em Serviço , Terapia da Linguagem , Fonoterapia , Inquéritos e Questionários
15.
J Int Neuropsychol Soc ; 20(8): 822-35, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25156204

RESUMO

Age-related memory changes are highly varied and heterogeneous. The study examined the rate of decline in verbal episodic memory as a function of education level, auditory attention span and verbal working memory capacity, and diagnosis of amnestic mild cognitive impairment (a-MCI). Data were available on a community sample of 653 adults aged 17-86 years and 70 patients with a-MCI recruited from eight broad geographic areas in Greece and Cyprus. Measures of auditory attention span and working memory capacity (digits forward and backward) and verbal episodic memory (Auditory Verbal Learning Test [AVLT]) were used. Moderated mediation regressions on data from the community sample did not reveal significant effects of education level on the rate of age-related decline in AVLT indices. The presence of a-MCI was a significant moderator of the direct effect of Age on both immediate and delayed episodic memory indices. The rate of age-related decline in verbal episodic memory is normally mediated by working memory capacity. Moreover, in persons who display poor episodic memory capacity (a-MCI group), age-related memory decline is expected to advance more rapidly for those who also display relatively poor verbal working memory capacity.


Assuntos
Envelhecimento , Disfunção Cognitiva/complicações , Deficiências da Aprendizagem/etiologia , Transtornos da Memória/etiologia , Memória de Curto Prazo/fisiologia , Aprendizagem Verbal/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Análise de Regressão , Características de Residência , Adulto Jovem
16.
PLOS Glob Public Health ; 4(2): e0002847, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38394160

RESUMO

Critical facets of our lives have been disrupted by the COVID-19 outbreak for almost three years. During this time, there has been a lot of clinical and research interest in issues related to mental health. However, few have examined the pandemic's long-term psychological effects. The aims of the present study were to assess the long-term psychological impact of the pandemic COVID -19, five months after the first wave restriction measures were lifted, to identify high-risk groups and to address the use of precautionary measures (PM). Information about sociodemographic characteristics, mental health, coping mechanisms, and compliance with precautionary measures (PM) were all gathered in Cyprus through an anonymous online survey. The poll was completed by 1128 people (73% of whom were female). For the purposes of the present study, descriptive statistics and structural equation modeling were used. 32.3% of participants experienced moderate-to-severe anxiety symptoms, where 16.4% and 23% reported moderate-to-severe depression and post-traumatic stress symptoms respectively. Lower levels of anxiety, depression, and post-traumatic stress symptoms as well as greater compliance to PM were linked to higher levels of resilience. Additionally, subgroups of participants, at a higher risk for negative psychological effects were identified, such as women and young adults. Our findings demonstrate the long-lasting effects of the COVID-19 pandemic on mental health and provide guidance on how to deal with similar situations. It also raises questions about the concurrent effects on people with the long COVID syndrome.

17.
Eur J Pain ; 2024 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-39352076

RESUMO

BACKGROUND: Despite functional connectivity network dysfunction among individuals with headaches, no studies have examined functional connectivity neural correlates and anatomical differences in coping with headaches. METHODS: This study investigated inter-individual variability in whole-brain functional connectivity and anatomical differences among 37 individuals with primary headaches and 24 age- and gender-matched controls, and neural correlates of psychological flexibility (PF) that was previously found to contribute to headache adjustment. Participants (84% women; M headache severity = 4/10; M age = 43 years) underwent functional magnetic resonance imaging scans and completed questionnaires to examine global and subnetwork brain areas, and their relations with PF components, controlling for age, gender, education, and head-motion. RESULTS: Seed and voxel-based contrast analyses between groups showed atypical functional connectivity of regions involved in pain matrix and core resting-state networks. Pain acceptance was the sole PF component that correlated with the cerebellum (x, y, z: 28, -72, -34, p-false discovery rate <0.001), where individuals with headaches showed higher grey matter density compared to controls. CONCLUSIONS: The cerebellum, recently implicated in modulating emotional and cognitive processes, was indicated to process information resembling what individuals do when practicing pain acceptance. Our findings establish for the first time this connection of the cerebellum and its role in pain acceptance. We propose that pain acceptance might be a behavioural biomarker target that could modulate problematic headache perceptions and brain networks abnormalities. SIGNIFICANCE: This study highlights the potential use of emerging behavioural biomarkers in headache management, such as pain acceptance, and their role in modifying the headache experience. Notably, grey matter reorganization in the cerebellum and other known brain pain networks, could indicate brain networks that can be modified from targeted behavioural interventions to help decode the nociplastic mechanisms that predominates in headaches.

18.
Front Sports Act Living ; 6: 1418439, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39346497

RESUMO

Obstructive sleep apnea (OSA) is associated with a number of adverse health effects, particularly on brain health. Chronic sleep disruption caused by OSA can adversely affect cognitive health. Exercise is recommended as a non-pharmacological intervention for patients who are intolerant to continuous positive airway pressure (CPAP) and has been shown to have beneficial effects on brain health and cognitive function. This protocol aims to investigate the effects of a 12-week tele-exercise program on cognitive function and specific parameters of brain activity, including brain metabolism and oxygenation, in patients with OSA. The project aims to demonstrate the multidimensional relationship between exercise, cognition, and brain oxygenation/metabolism. Our local ethics committee has approved the study. Our population sample (Group A, OSA with cognitive impairment (CI) and tele-exercise; Group B, OSA with CI and no tele-exercise; Group C, OSA without CI and no tele-exercise) will undergo assessment both before and after a 12-week tele-exercise intervention program. This assessment will include a comprehensive battery of subjective and objective assessment tests. Data will be analyzed according to group stratification. We hypothesize a beneficial effect of tele-exercise on sleep and cognitive parameters, and we are confident that this study will raise awareness among healthcare professionals of the brain health benefits of exercise in patients with low compliance to CPAP treatment. The protocol of our manuscript entitled "The impact of a 12-week tele-exercise program on cognitive function and cerebral oxygenation in patients with OSA: Randomized Controlled Trial -Protocol Study" has been registered on ClinicalTrials.gov with ID NCT06467682.

19.
Lancet Healthy Longev ; : 100625, 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39389083

RESUMO

BACKGROUND: The effect of hearing and vision difficulties on the risk of developing dementia and worsening outcomes in people already living with dementia is well established. We evaluated the clinical impact of a hearing and vision rehabilitation and support programme on quality of life in people with mild-to-moderate dementia and concurrent sensory difficulties. METHODS: We conducted a parallel-group, multicentre, observer-blind, superiority randomised controlled trial in seven older adult clinics in five European countries (Cyprus, France, Greece, Ireland, and the UK). People with mild-to-moderate dementia with adult-acquired hearing difficulties, vision difficulties, or both were randomly assigned (1:1) along with their care partner to an 18-week home-basedsensory support intervention (SSI) of tailored hearing and vision rehabilitation and support, or to care as usual. Randomisation was blocked (block size of four, six, or eight) and stratified by country, with allocation assigned via a remote web-based system. The SSI included: full hearing assessment, vision assessment, or both; fitting of hearing aids, glasses, or other sensory aids; and home-based support from a sensory support therapist to assist adherence and uptake of sensory aids, foster social networking, and optimise the home sensory environment. Care as usual involved no additional intervention beyond services normally available to people with dementia at the respective sites. The primary outcome was health-related quality of life (Dementia Quality of Life Instrument [DEMQoL]) score at 36 weeks, reported as an adjusted mean difference. Analyses were done according to the intention-to-treat principle. This trial is registered with the ISRCTN Registry, ISRCTN17056211. FINDINGS: Between May 4, 2018, and May 6, 2021, 252 people with mild-to-moderate dementia were randomly assigned, of whom 251 (n=126 in the SSI group and n=125 in the care as usual group) were included in the analysis. The mean age of participants was 79·6 years (SD 5·8), and 132 (53%) were women. After a median follow-up time of 37·7 weeks (IQR 36·2-39·0), the mean DEMQoL score was 92·8 (SD 15·2) in the SSI group and 92·8 (14·0) in the care as usual group (adjusted difference 0·18, 95% CI -2·13 to 2·30, p=0·87). Among 114 adverse events reported for 56 (44%) participants in the SSI group, ten events in nine participants were related or possibly related to the intervention (medical device pain or discomfort n=6, ear pain n=1, scratch to the ear n=1, sore eye n=1, redness n=1; all of grade 1). Serious adverse events were reported for 25 (20%) participants in the SSI group and 16 (13%) in the care as usual group. Six (5%) participants in the SSI group and five (4%) in the care as usual group died. None of the serious adverse events or deaths were related to the study intervention or procedures. INTERPRETATION: This study showed no improvement in quality in life in participants who received the intervention in the longer term. Sensory difficulties are common in people with dementia and interventions aimed at improving sensory-cognitive health should be explored further. FUNDING: EU Horizon 2020.

20.
Front Med (Lausanne) ; 10: 1161060, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37153102

RESUMO

Introduction: An essential element of quality aging is the maintenance of cognitive and psychosocial functioning. The principal objective of the present paper was to present the theoretical framework, content and process evaluation of a newly developed multi-dimensional group intervention designed to strengthen/improve areas of cognitive and psychosocial functioning in adults over 65. Methods: The intervention implements multiple methodologies aiming to facilitate contextual integration of learned concepts and strategies derived from clinical psychology and rehabilitation. It moves seamlessly on the cognition-emotion axes and consists of five active ingredients selected to address challenges associated with aging: Memory Compensatory Strategies, Problem-Solving, Emotion Regulation, Mindfulness, and Locus of Control. Thirty participants joined the intervention group aged 65-75 years (M = 69.03; SD = 3.04). All 30 participants who were included in the intervention group completed the program. Results: Results from the Participant Satisfaction Scale indicate that the program was perceived very positively by participants, who also reported implementing their newly learned strategies in activities of daily life. Furthermore, there was high correlation between internal locus of control and the learned strategies. Discussion: The outcomes of this analysis indicate that the intervention is feasible and well tolerated by our target group. This multidimensional intervention may offer a valuable contribution to public health care and dementia prevention for older adults. Clinical Trial Registration: [https://clinicaltrials.gov/ct2/results?cond=NCT01481246], identifier [NCT01481246].

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